Nationwide, W.Va. second in Medicaid expansion

The number of people getting health insurance through Medicaid and the Children’s Health Insurance Program has increased more in West Virginia than in almost any other state since Medicaid was expanded under the Affordable Care Act, according to data from the federal government released Wednesday.

As of April 30, nearly 154,000 West Virginians had enrolled in one of the programs since September of last year, when open enrollment began under the federal health care law.

That makes for an increase of more than 43 percent in Medicaid and CHIP enrollment, the second largest of any state in the country, trailing only Oregon, where enrollment increased by nearly 50 percent.

In total, 508,496 West Virginians — more than a quarter of the state — now have health insurance under one of the two programs, according to numbers submitted by the state to the federal Centers on Medicare and Medicaid.

The Affordable Care Act expanded Medicaid eligibility to anyone who makes up to 138 percent of the federal poverty level, about $33,000 for a family of four. Prior to the expansion, different states had different eligibility levels for Medicaid, and, for adults, West Virginia’s was one of the least generous.

Many low income children and pregnant women could get health insurance through Medicaid or CHIP, but it was very difficult for low-income parents to get Medicaid. Parents could only get Medicaid if they made less than 35 percent of the federal poverty level, about $8,300 for a family of four, and adults without children were completely ineligible.

“Some states had much broader eligibility and did permit childless adults into the program,” said Brandon Merritt, a health policy analyst at the West Virginia Center on Budget and Policy, a left-leaning think tank. “West Virginia was not very generous when it came to eligibility levels.”

Part of the reason why the state has signed up so many people is that its expansion covered more ground than most of the 25 other states that chose to expand Medicaid — there was a huge number of West Virginians that became newly eligible.

Twenty-four states, all with Republican governors, are either still considering Medicaid expansion or have chosen not to expand it.

After Gov. Earl Ray Tomblin chose to expand Medicaid eligibility, the state aggressively moved to notify people that would be newly eligible.

West Virginia was one of only five states, including Oregon, that used an auto-enrollment tactic recommended by the federal government called “administrative transfer.”

Because people in the Supplemental Nutritional Assistance Program (SNAP, formerly food stamps) were likely to have low enough incomes to make them eligible for expanded Medicaid, the state sent a letter to everyone who receives SNAP benefits asking them if they would like to sign up for expanded Medicaid. They also sent those letters to parents whose children had Medicaid, but who did not have coverage for themselves. Letters were initially sent to about 117,000 people, and then an additional 15,000 people about a month later, Jeremiah Samples, deputy secretary of the state Department of Health and Human Resources, said.

The state then followed up with phone calls and another letter, to let people know that they would be eligible for Medicaid.

The state signed up more than 70,000 people for Medicaid in this way.

“For a government agency to send out not just one but two letters, and make sure it was in plain English, and then follow it up with a phone call is pretty much above and beyond what most states did,” Merritt said.

The federal government pays for 100 percent of the Medicaid expansion for the first three years, and 90 percent thereafter.

Candidates for federal office in West Virginia are still split along party lines on Medicaid expansion. Democratic candidates say the state should continue to go forward with it, while fixing other parts of the law.

Republican candidates have repeatedly, and continue to, call for the full repeal of the Affordable Care Act, and thus, the Medicaid expansion. Rep. Shelley Moore Capito and state Sen. Evan Jenkins, both Republican candidates for federal office, recently would not answer when asked whether the state should continue to move forward with Medicaid expansion, absent the unlikely repeal of the ACA.

Reach David Gutman at or 304-348-5119.

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